A Case of Dariers Disease Treated with Adapalene / 대한피부과학회지

Dariers disease is inherited as an autosomal dominant trait and characterized by follicular pruritic hyperkeratotic papules. The onset is usually in late childhood and the course of the disease is chronic and slowly progressive in most cases. Dariers disease is refractory to treatment with most conventional keratolytics and anti-inflammatory agents. To date, oral and topical retinoid products have been the mainstay therapy for this population, but local as well as systemic side effects often limit their effectiveness. We present a case of localized Dariers disease which responded promptly to the topical application of adapalene 0.1% gel without side effects. A review of treatment for Dariers disease also is presented.

A Clinical and Histopathological Study of Parapsoriasis / 대한피부과학회지

BACKGROUND: Parapsoriasis described a group of cutaneous disease that can be characterized by scaly patches or slightly elevated plaques that have a resemblance to psoriasis, hence the nomenclature. Up to now, a uniformly accepted definition of parapsoriasis remains lacking. OBJECTIVE: The purpose of this study was to evaluate the clinical and histopathological features of parapsoriasis in Korea. METHODS: The clinical charts, photographs and skin biopsy slides of patients who had been clinically diagnosed as parapsoriasis at the initial visit were reviewed. Then the evaluation of age at onset, sex distribution, disease duration, anatomical distribution, clinical features of the skin lesions, associated symptoms, family history, co-existing disease, and histopathologic features were conducted. Six cases from small plaque parapsoriasis group and four cases from large plaque parapsoriasis group were investigated for the presence of TCR gene rearrangement using a PCR technique. RESULTS: The male to female ratio was 1: 1.2. The average ages of onset in large plaque type and small plaque type were 44.7 and 32.9 years respectively. 1) According to the clinical classification, 7 (29%) of the patients had large plaque type and 17 (71%) had small plaque type. 2) Many lesions of large plaque parapsoriasis group exhibited varying degrees of epidermal atrophy, fine wrinkles and telangiectasia. 3) Large plaque parapsoriasis showed more histologic changes consisting of epidermal atrophy, exocytosis and atypical lymphocytes. 4) Monoclonal T-cell receptor gene rearrangement was not detected in all of 10 patients with large and small plaque parapsoriasis. CONCLUSION: In our study, some of our findings are in agreement with those already in the literature, whereas others, particularly the male to female ratio and constitutional symptoms, differ. Our results also indicate that there are many clinical and pathological differences between large plaque and small plaque parapsoriasis.

A Case of Benign Fibrous Histiocytoma on Herpes Zoster Scar: Wolf's Isotopic Response

No abstract available.

Clinical trial of 5% Imiquimod Cream for Eleven Cases of Infantile Hemangioma / 대한피부과학회지

BACKGROUND: Infantile hemangioma is a common benign tumor with preponderance in females. Even though most of them have self-limiting course after growing phase, many parents seek more effective and less aggressive therapy. Motivated by a report on the experience of successful treatment with imiquimod, we planned to confirm the beneficial effect of imiquimod on the regression of infantile hemangioma. OBJECTIVE: To enhance the noninvasive treatment modality of infantile hemangioma. METHODS: Eleven patients with various ages were enrolled in this study. Eight female and three male patients applied 5% imiquimod cream every other day or daily. RESULTS: There was no statistically significant difference of treatment results between both sexes. The number of lesions and locations didn't alter the outcome. But, the growing phase versus regression phase affected the response to treatment significantly after two months of application. As a whole, most of the patients tolerated the imiquimod well. Three of them experienced mild scales and erosions. One showed shallow ulcers and crusts that needed medical treatments. But, by reducing the frequency of application and some dressings, all the complications were managed well and didn't hinder the therapy. There were no significant systemic adverse effects. CONCLUSION: Imiquimod is effective for infantile hemangioma regardless of site of occurrence, especially when used early in growing phase. It is noninvasive and relatively safe method. For a beneficial effect, the therapy must be continued for at least two months.

Topical Treatment with 5% Imiquimod for Solitary Keratoacanthoma / 대한피부과학회지

Keratoacanthoma is a rapidly growing tumor, histologically resembling squamous cell carcinoma. Although it may regress spontaneously, keratoacanthoma is routinely treated by excision. Here we report the successful therapeutic use of imiquimod 5% cream for the treatment of keratoacanthoma. The patient was 35-year old Korean man with solitary dome-shaped nodule on his nose. On the basis of clinical and histopathological examination, the diagnosis of solitary keratoacanthoma of mature stage was made. The tumor mass fully regressed under topical treatment with imiquimod 5% cream within 38 days. No recurrence occurred during a six months follow up period. Imiquimod can be an effective non-operative therapeutic modality for keratoacanthoma.

A Case of Cutaneous Plasmacytoma Treated with Thalidomide / 대한피부과학회지

Cutaneous involvement has been reported in all types of malignant plasma cell disorders including multiple myeloma, solitary myeloma of bone, plasma cell leukemia, and extramedullary plasmacytoma. But metastatic plasmacytomas in the skin are rare in multiple myeloma and extramedullary plasmacytoma. If skin tumors appear during the course of multiple myeloma, these should be interpreted as a sign of poor prognosis. Treatment of patients with resistant multiple myeloma is challenging. Thalidomide has recently shown antitumor activity in patients with refractory myeloma. Until the introduction of thalidomide, no drugs other than cytotoxic agents and glucocorticoids had shown antitumor activity to cutaneous plasmacytoma. We recently performed a clinicopathologic study of a patient with cutaneous involvement of multiple myeloma and reported our result with thalidomide therapy in this patient.

A Case of Basal Cell Carcinoma of the Nose Successfully Treated with 5% imiquimod Cream / 대한피부과학회지

Basal cell carcinoma is the most common malignant skin lesion. The major aim in the treatment of basal cell carcinoma is the curative treatment, which is best done by Mohs excision of the neoplastic tissue. Despite the effectiveness of surgical excision, non-surgical treatment modalities may be preferred for large tumor size or poor patient performance status. Imiquimod may offer an alternative to surgical excision. Imiquimod is an immune modulator acting as IFN-alpha and other cytokine inducer, stimulating the innate immune response. Imiquimod's anti-tumor effect may be mediated by IFN-alpha, IFN-gamma, IL-12. At this time, there is no published experience on the treatment of basal cell carcinoma with imiquimod in Korea. We report a case of basal cell carcinoma of the nose successfully treated with topical 5% imiquimod cream.

Hypopigmentation Occurred After Er: YAG Laser Resurfacing / 대한피부과학회지

BACKGROUND: Hypopigmentation is one of the complications developed after laser resurfacing. There have been few data about hypopigmentation developed after Er: YAG laser resurfacing, especially in darker skin. OBJECTIVE: The objective of this study was to assess the clinical and histopathologic features of hypopigmentation developed after Er: YAG laser resurfacing. METHODS: One hundred and ninety patients have been included in this study. Ninety seven patients were treated with short pulsed Er: YAG laser, 2mm spot sized handpiece at the setting of 12.5-15.0J/cm2. Fifty two patients were treated with variable pulsed Er: YAG laser, 5mm spot sized handpiece at the setting of 7.0-7.5J/cm2 and 7msec pulse duration. Forty one patients were treated with dual mode Er: YAG laser, 4mm spot sized scanner at the setting of 17.5J/cm2 ablation mode and 3.15J/cm2 coagulation mode. Incidence, time of onset, duration of hypopigmentation were evaluated throughout the medical charts and serially checked photographs. Skin biopsy was performed in four patients at the hypopigmentation site for histopathologic and electron microscopic examinations with informed consents. RESULTS: Hypopigmentation was observed in twenty six patients; eight in short pulsed Er: YAG laser, eight in variable pulsed Er: YAG laser, ten in dual mode Er: YAG laser. According to the time of onset of hypopigmentation, twelve patients developed hypopigmentation within one month, five patients in two months, three patients within three months, three patients within four months, two patients within five months, and one patient within six months. Twenty out of twenty six patients recovered skin coloration within six months, and two patients within twelve months. On the other hand, four patients had persisted hypopigmentation for more than one year. Melanosome appeared to be decreased but melanocytes appeared to be present in normal numbers on the histopathologic and electron microscopic examinations. CONCLUSION: Although hypopigmentation is one of the frequent complicaions of Er: YAG laser resurfacing, it is temporary in most cases. Thermal damage due to long pulse duration of laser seems to be a very important factor in inducing hypopigmentation.

A Case of Successful Combination Therapy of Systemic Steroid and Topical 0.03% Tacrolimus for Pyoderma Gangrenosum in a Patient with Myelodysplastic Syndrome / 대한피부과학회지

Pyoderma gangrenosum is one of the neutrophilic dermatoses, which is usually related to many systemic diseases such as inflammatory bowel diseases, hematologic diseases, etc. Its typical clinical feature is usually a solitary, painful, margin-elevated ulcer. We herein report a case of myelodysplastic syndrome-related pyoderma gangrenosum, treated with a combination therapy of systemic steroid and topical 0.03% tacrolimus oint.

A Case of Localized Cutaneous Leishmaniasis in A Native Korean / 대한피부과학회지

Localized cutaneous leishmaniasis is a chronic ulcerative, usually self-limiting skin disease, and one of the major tropical diseases. This disease is caused by an infection of genus Leishmania, transmitted by a sandfly, and there are some cases of cutaneous leishmaniasis in Koreans after travelling abroad in endemic areas, such as the Middle East and Africa. We report a case of localized cutaneous leishmania in a 70-year-old native Korean man without history of a trip abroad.

Two Cases of Alopecia Areata Treated with Anthralin / 대한피부과학회지

Alopecia areata (AA) is a recurrent, nonscarring type of hair loss. Although it is a medically benign condition, AA can cause great emotional distress to affected patients and their family. At this time, there are many treatments that have varying efficacies but there is no reliable cure. Topical anthralin treatment of AA has been found to be effective by some researchers. We experienced two cases of AA improved by topical anthralin therapy without serious side effects. Anthralin is much less expensive than most other topical therapies for AA and relatively well tolerated. In our experience, it is more effective in eliciting a cosmetic response than other topical treatments. Anthralin appears to be a reasonable therapeutic option for AA.

Clinical Application of BCA Focal Treatment for Various Skin Diseases: Surgical Gems II / 대한피부과학회지

Bichloroacetic acid(BCA), one of the chloroacetic acids, is an effective tissue cauterant when used in high concentration. In dermatologic surgery, BCA, in the form of 100% solution, has been used to treat xanthelasma, sebaceous hyperplasia, verrucae, hard and soft corn, seborrheic keratosis, ingrowing nail, cysts. The cauterization with BCA 100% solution can be used with a simpler technique than the surgical excision or electrical cauterization, without complicated appliance such as LASER generators, so the dermatologic surgical technique - BCA chemical cauterization, topical treatment - can be selected as a treatment of choice for many dermatologic conditions in outpatient offices. BCA destroys the barrier function of the epidermis and penetrates deeply through the papillary dermis and then creates the effect in the papillary dermis and reticular dermis. As a result, regeneration of new dermal collagens and a new epidermis occurs. This pharmacologic effect of BCA makes 100% solution of BCA to be used in the treatment of xanthelasma, pigmented nevi, acne scars with good clinical outcomes.

A Case of Desmoplastic Trichoepithelioma Associated with Syringomas / 대한피부과학회지

Desmoplastic trichoepithelioma is a rare benign adnexal tumor that usually presents as an asymptomatic, firm, annular plaque. It most commonly occurs on sun-exposed areas in middle-aged women, especially on the face. Patients typically give a history of a single, slow-growing lesion that has been present for several years. The diagnosis of desmoplastic trichoepithelioma can be made when a triad of microscopic findings are observed in combination with a compatible clinical picture. We herein report a case of desmoplastic trichoepithelioma associated with syringomas on the face of a young woman.

Surgical gems in dermatologic surgery I / 대한피부과학회지

A bolster, simply defined, is any device used to support or cushion. In surgery, bolsters have been used under sutures to reduce skin and subcutaneous tension. Bolsters function to reduce the potential for necrosis and laceration by distributing the wound closure tension over a broader surface area. Pexing stitich is placed between the mobilized tissue and the deep fascia and periosteum to prevent the secondary motion of closure from disrupting anatomic landmarks and moveable structures. The technique aids in obtaining linear closures, prevents distortion of free margins, prevents tenting across concavities, and fixes the closure line at the junction of cosmetic units. Standard treatment of lipoma commonly includes incision with extrication or elliptical excision. Unfortunately, these treatments often elicit a large scar. Using pressure technique, risk of hemorrhage and infection may be minimized secondary to the decreased degree of invasion. In cosmetically sensitive areas, this technique is an effective and aesthetically pleasing method for removal of lipoma.

A Case of Pyogenic Granuloma on the Tongue / 대한피부과학회지

Pyogenic granuloma is a relatively common entity first described by Poncet and Dor in 1897 as 'human botryomycosis'. It may occur anywhere on the skin, including the mucosal surface, but is most common on the fingers, around the nails, on the face and on the scalp. The tongue is a rare location for its occurrence. There is controversy as to etiology of pyogenic granuloma and conservative excision is the treatment of choice. We describe a 41-year old woman with a solitary protruding nodule on the tongue that was treated by excision and electric cautery.

A Case of Tufted Hair Folliculitis / 대한피부과학회지

Tufted hair folliculitis is an inflammatory disorder of the scalp characterized by a peculiar tufting of hair within areas of scarring alopecia. Histopathological studies reveal perifollicular inflammation around the upper portions of the follicles sparing the hair root level. Within areas of inflammation, several follicles converge toward a common follicular duct with a widely dilated opening. The cause of tufted hair folliculitis is unknown, and the therapeutic approach is problematic. We present herein a patient with a 28-year history of recurrent and progressive tufted hair folliculitis. A 33-year-old man was referred to our department for the treatment of chronic and relapsing inflammatory lesions of the scalp. The clinical examination revealed a circumscribed area of 15cm length and 10cm width on the occipital area of the scalp which was characterized by hair tufting and exudates. Histopathologic findings were typical for tufted hair folliculitis. We believe that hair tufting is a secondary phenomenon which may occur in several inflammatory diseases of the scalp.